Transcript Overview/Update Child and Family services Reviews Child and Family Services Reviews, Program Improvement Plans: What’s the Link with CRP?

Overview/Update Child
and Family services
Reviews
Child and Family Services
Reviews, Program Improvement
Plans: What’s the Link with
CRP?
CFSR: Introduction
• Assess child and family outcomes
• Focus on program improvements
• Build agency capacity to self-evaluste
CFSR: History
• Previous federal review systems
– Focused on documentation
– Did not emphasize capacity building or
program improvement
CFSR History
• Legilative Reforms
• Adoption and Safe Families Act
• Incentives and resources
CFSR: Related Legislation
• Created a new child and family
services reviews monitoring system
• The Children’s Bureau, Administration
for Children and Families, administers
the reviews
• Reviews examine all child welfare
programs
CFSR Review Process
Two Review Phases
– Statewide Assessment
– Onsite Review
– Program Improvement Plan
CFSR: Review Concepts
• Federal and State government collaboration
• Uses multiple information sources to assess
State performance
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Statewide Assessment
State child welfare data
Case record reviews and interviews
Interviews with stakeholders
CFSR Review Concepts
• Outcomes of services provided to children
and families served
– Safety
– Permanency
– Child and family well-being
CFSR Review Concepts
• Systemic Factors
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Training
Quality assurance
Foster and adoptive homes
Case review
Service array
Statewide Information system
Agency responsiveness to the community
CFSR: Review Concepts
• Comprehensive review of services for
children and families
• How programming affects positive
outcomes for children and families
CFSR: Review Concepts
• Identifies State agency strengths and needs
• Emphasizes making improvements
CFSR: Review Concepts
• Promotion of sound practice principles
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Family-centered practice
Community-based services
Individualizing services
Strengthening parental capacity
CFSR: Review Concepts
• Emphasize accountability
• Focuses on enhancing State quality
assurance systems
Initial Round of CFSR Reviews
• First State reviewed: Delaware 03/01
• Last State reviewed: New Jersey 03/04
CFSR PIP Status
(as of 05/08/06)
• 52 Approved PIPs
• 33 States have completed the 2-year PIP
implementation period
• ACF has completed evaluation of 18 of the 33
State PIPs and determined that 17 States achieved
all goals and required activities – thus rescinding
any applicable penalties
• Evaluations of the remaining PIPs are pending
Goals of the PIP Process
• Improve outcomes for children and families
• Strengthen delivery of effective services
• Coordinate partnerships throughout child
welfare
• Establish ongoing self-monitoring and
continuous improvement
Limitations of PIP Analysis
• Linking progress with specific strategies
• Various stages of PIP completion
• Numbers are approximate
Safety
State Performance on Safety Outcomes
Substantial Conformity: 6 States each for both
Safety Outcomes
Case Ratings:
Low
Median
High
Safety 1
62%
85.8%
100%
Safety 2
48%
80.8%
93.5%
Common Safety Concerns from Initial
CFSRs
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Lower risk reports not investigated timely
Reports on open cases not investigated
Insufficient risk or safety assessments
Inconsistent services to protect children at home
Inconsistent services to address risk, especially
in in-home cases
• Inconsistent monitoring of families
Common Safety Strategies in
Program Improvement Plans
• Develop new practices or processes (47 States)
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focus on revising risk and safety assessments
alternative/differential response systems
engagement and planning with families
enhance practices and processes to improve practice and
consistency (focused on practice models)
– create special units or reorganize units
• Develop or enhance policies (38 States)
– clarify policies around investigations, such as timeframes
– disposition process
Common Safety Strategies in
Program Improvement Plans (continued)
• Training (38 States)
– focus on developing skills of staff
– supervisors
– cross-train community partners, foster parents,
residential staff and law enforcement
• Info Systems (25 States)
• Services ( 21 States)
– develop new services
– enhance existing services
Common Safety Strategies in
Program Improvement Plans (continued)
• Research and evaluation ( 21 States)
– study areas of substance abuse, juvenile justice, and domestic
violence
– analyze specific populations
– pilot specific practices
• Collaboration (16 States)
– focus on collaboration with community partners, other State
agencies
– implement strategies to work with tribes to cross-train and
provide services
• Supervision ( 11 States)
– focus on supervisors’ role and oversight responsibilities related
to safety/risk assessments, in-home services cases, etc.
Permanency
State Performance on Permanency
Outcomes
Substantial Conformity:
•0 States in substantial conformity on Permanency Outcome 1.
•7 States in substantial conformity on Permanency Outcome 2.
Case Ratings:
Low
Median
High
Permanency 1
7.1%
50.9%
92%
Permanency 2
37.9%
77.3%
94.3%
Common Permanency Concerns in
Initial CFSRs
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Case goal of LTFC established without ruling out options
Inconsistent concurrent planning efforts
Maintaining goal of reunification too long
Not filing for termination of parental rights timely
Adoption studies and paperwork not completed timely
Lengthy TPR appeals process
Reluctance of courts to terminate parental rights
Overcrowded court dockets
Common Permanency Strategies
in Program Improvement Plans
• Develop or enhance policies (all States)
– Case planning, procedures, hearings, etc.
– Legislation
– Practice guidelines
• Develop new practices/procedures (all States)
– General casework practices
– “Best practice” models
– Targeted services
• Quality assurance and monitoring activities (at least 45 States)
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Improvements in data/systems
Improvements in supervision
Review of specific populations
Establishing new practice standards
Common Permanency Strategies in
Program Improvement Plans (continued)
• Collaborative activities (at least 38 States)
– Memoranda of Understanding (MOU) or interagency agreements
– Courts/legal/judicial issues
– Tribes, youth, other stakeholders
• Training (at least 38 States)
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Cross training
Worker and supervisor training
Foster and adoptive parent training
Policy training
• Increase or Enhance Resources (at least 35 States)
– Staff hiring/retention
– Funding
– New/expanded services
Well-Being
State Performance on Well Being
Outcomes
Substantial Conformity:
•0 States in substantial conformity on Outcome 1
•16 States in substantial conformity on Outcome 2
•1 State in substantial conformity on Outcome 3
Case Ratings:
WB 1
Low
18%
Median
60%
High
86%
WB 2
64.7%
83%
100%
WB 3
51.2%
69.9%
92.1%
Common Well Being Concerns in
Initial CFSRs
• Inconsistent match of services to needs
• Inconsistent in conducting needs assessments
• Lack of support services to foster and relative
caretakers
• Parents and children not involved in case planning
• Inadequate caseworker visits with children and
parents
• Failure to engage fathers
Common Well Being Concerns in
Initial CFSRs (continued)
• Multiple school changes for children entering
foster care
• Lack of services to address education, physical
health, dental health, or mental health
• Lack of health and mental health assessments
• Few doctors/dentists that accept Medicaid
Comprehensive Needs
Assessments
Finding: Assessment of needs and
provision of services were associated
with the following:
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Permanency Outcome 1
Permanency Outcome 2
Safety Outcome 1
Safety Outcome 2
• Placement stability
• Meeting educational
needs
• Meeting physical health
needs
• Meeting mental health
needs
What strategies address
comprehensive needs
assessments?
• Practice change strategies (34 States)
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Revisions to tools
Consistency in practice
Improve engagement of family members and stakeholders
Implement practice models and/or processes
• Training of staff (16 States)
• Revise policy and procedures/strengthen existing policies (7 States)
– More frequent visits to children and families and designating a visit to be
spent on assessment and developing service plans
– Focus on consistency between counties and POS
• Oversight of practice through supervisors and managers (3 States)
Caseworker Visits with
Children and Parents
Finding: Caseworker visits with
children and parents were strongly
associated with:
• Risk of harm to children
• Needs & Services for children,
parents, foster parents
• Child and parent involvement
in case planning
• Services to protect children at
home
• Safety Outcome 1
• Safety Outcome 2
• Timely permanency goals
• Timely reunification
• Child’s visits with parents and
siblings
• Relative placements
• Meeting educational needs
• Meeting physical health needs
• Meeting mental health needs
What strategies address
caseworker visits with
children and parents?
• Establish minimum visit requirements (30 States)
• Provide supervisory oversight and monitor
performance through QA/CQI (30 States)
• Train managers, staff and providers (16 States)
• Focus on quality of visits (14 States)
• Recruitment and retention of staff (14 states)
• Streamline documentation of visits (3 States)
• Clarify roles and responsibilities of multiple parties
involved in a case (3 States)
Engagement of Fathers
• Seeking out relatives
Finding:
There were
significant
differences in
serving fathers and
mothers
in these areas:
• Assessing needs
• Providing services
• Engagement in case
planning
• Caseworker contacts
What strategies address
engagement of fathers in case
planning and service provision?
• Develop or revise existing policy and practice to
locate absent parents (4 states)
• Implement models of practice to assess, engage
and plan with fathers (4 states)
• Enhance and implement policy or procedures to
better engage and assess fathers (5 states)
• Enhance training and training curriculum to better
engage and plan with fathers (3 states)
Sustaining Change
How are States managing and
sustaining change?
• Local and State Qa systems
• Promote supervisory development
• Use QA results and data with local offices
and supervisors to change practice
• Use forums and stakeholder input to
analyze and correct problems
• Open communication between
administration and the field
What are the challenges to sustaining
change
• Not institutionalizing QA efforts or starting QA
reviews late in the PIP process
• PIPs that focus on “plan-to-plan” and do not fully
implement change
• Not addressing the need to change agency culture
• Not engaging stakeholders, particularly other State
entities, to assist with systems change
What were examples of the
challenges to PIP implementation?
• Economics/resource issues
• Unanticipated complexity of implementing
some strategies
• Lack of leadership
• Challenges in State/county relationships
• Low morale in the field and staff turnover
• Lack of coordination with other State
agencies and other key stakeholders
What were examples of State
successes in PIP implementation?
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Agency is speaking the same language
Use data in daily practice
Institute a learning organization via CQI
Change agency culture
Align Child Welfare, Juvenile Justice, mental health
through communication and common vision
Improve collaboration with community partners, connect at
planning level
Improve supervision to monitor casework
Obtain additional funding for new staff
Train the field on best practices initiatives
What were examples of the
challenges to PIP implementation?
• Issues with data quality and quality
assurance systems
• Over-reliance on training and policy
changes as a strategy
• Lack of alignment with Consent Decree and
other plans
• Failure to involve all levels of the agency in
PIP
How can states sustain the
improvements they make?
• Invest in values, belief, and vision
• Strengthen the practices that are linked to
outcomes
• Engage external stakeholders
• Engage counties
• Engage State legislatures
• Implement and use quality assurance
Okay…
Therefore…
• Do you know…
– What the findings of the CFSR review in your State
were?
– What your State PIP looks like?
– What strategies and goals are being addressed in your
State PIP?
– Where your State is in the PIP process
– Where your State is in the CFSR process, particularly
as it relates to round 2
– Who the State child welfare agency staff person is who
coordinates CFSR related activities?
Therefore…
• If your answers are no
– Please make contact with your State’s CFSR
coordinator and express your desire to be
involved
– Find out how your State PIP is being
implemented and monitored
– Look for public information that can inform
your requests for specific information from the
State child welfare agency
Children’s Bureau Website
• www.acf.hhs.gov/programs/cb